It's me versus the patients

Copperfield is getting ever more belligerent with unreasonable patients - it might alarm his appraiser, but guess what? Sometimes it works

I'm getting worse as I get older. And I was pretty bad to start with. As a naive young GP, I'd only been on Planet Primary Care for five minutes before I realised things were more complex than those punter-hugging educationalists had led me to believe. And by the end of my first day, I was ready to change sides - the only obstacle being that although I'd worked out who the enemy was (the patients, stupid), I couldn't figure out who were my allies.

That baptism of fire taught me an important lesson. Specifically, that some patients are system-sucking leeches who require my advocacy like a burglar needs me to lend him a ladder. The only way to equilibrate the doctor-patient relationship - if you, too, develop the default attitude that many patients are feckless parasites - is to adopt the persona of Dr Complete Git.

Which must be why, each year, my appraiser strokes his chin thoughtfully and says, 'I sense a lot of anger in you, Dr Copperfield.' No kidding? And these days you have to factor in age and experience, which up the ante. After all, I originally viewed being stroppy as a duty. It wasn't nice, but it helped me separate patients' wants from their needs. And I innocently assumed that mopping the post-consultation blood from the floor was what Neighbour's housekeeping chapter was all about.

Nowadays, though, I consider good rows with patients a perk of the job. A day without a fight over a course of amoxicillin, or a referral to a specialist or a request for yet more methadone to 'accidentally drop under a passing lorry' leaves me feeling curiously unfulfilled.

Unbridled belligerence

My consultation belligerence has reached the point that I'm as scary as that bloke down the pub with pin-point pupils and no neck. So, these days, there's no 'How can I help you?', 'A sick note? Let's talk it through' and 'I can see why you find my diagnosis of "nerves" hard to accept'.

No. Now it's 'What the f**k do you want?', 'Are you having a larf?' and 'Do you want to settle it outside?'

But my favourite provocative technique - when confronted by an outright and outrageous demand - is to turn the tables. So, when Truculent Basildon Bloke opens with: 'I need tests on my back and I want to see a specialist,' I simply pass him the radiology form and say: 'Sure, there you go, and don't forget to specify whether you want an X-ray, an MRI or a myelogram.' Then I chuck the dictaphone his way, adding: 'And you can do the sodding referral letter, too, if you're such a bloody orthopaedic expert.'

You probably think I'm making this up. But the truth is that, recently, this approach resulted in a constructive doctor-patient dialogue about the pointlessness of investigating simple back pain in fat, angry Essex men. 'Nobody's ever explained it to me like that before,' said the patient, which I can believe. Then he apologised for being stroppy. It was, he explained as he skulked out of the door, all his mum's fault.

Whatever. A battle won. But the war continues.

Dr Tony Copperfield is a GP in Essex. You can email him at tony copperfield@hotmail.com